Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002

Abstract

Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10 000 infant deaths in the UK and at least 50 000 in Europe, the USA, and Australasia. Attenuation of the observed harm with increased adoption of the front position probably reflects a "healthy adopter" phenomenon in that families at low risk of SIDS were more likely to adhere to prevailing health advice. This phenomenon is likely to be a general problem in the use of observational studies for assessing the safety of health promotion.

Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location – Moving the discussion forward

“…All confirmed the association between prone infant sleep position and SIDS, leading to wide-scale 'Back to Sleep' campaigns, and dramatic reductions in infant deaths (e.g. Golding et al 1992;De Jonge et al 1993;Irgens et al 1995;Markestad et al 1995, Gilbert et al 2005.…”

“…Practices, behaviors and beliefs involve three 'levels of parental engagement' with SIDS-risks that require different approaches for effective intervention: a) Infant-care practices are relatively simple actions performed by parents, involving little engagement or cultural value. As a simple practice infant sleep position was easily modifiable, and as widespread prone infant sleep resulted from medical recommendations emanating from the care of pre-term infants in the mid-twentieth century, it was not a culturally embedded phenomenon (Gilbert et al 2005). Although supine infant sleep recommendations are challenged in some quarters (Hackett 2007;Moon et al 2010) overall implementation met little parental resistance.…”

Pragmatic Trials

“…62 63 An example is the use of case-control methods to evaluate the impact on the incidence of sudden infant deaths of advice about sleep position and other aspects of babies' sleeping environment. [64][65][66] A crucial aspect of the design of an evaluation is the choice of outcome measures. You need to think about which outcomes are most important, and which are secondary, and how you will deal with multiple outcomes in the analysis.…”

At the dawn of personalized reproductive medicine: opportunities and challenges with incorporating multigene panel testing into fertility care

“…However, risk factors with comparable odds ratios have made significant clinical and societal impacts, even in the context of low absolute risk. For example, prone sleeping position is associated with an increased risk of sudden infant death syndrome (SIDS) when compared to back sleeping position, with a pooled odds ratio of 4.46 (from a meta-analysis of 25 studies) [12]. Though the absolute risk of SIDS was only around one in every 1000 births at the time [13], the identification of prone sleeping as a risk factor still influenced the launch of a national "Back to Sleep" campaign in 1994 by the National Institute of Child Health and Development [14].…”